After a successful Ablation for AFlutter in Nov ‘21, I developed PAF early ‘22. Initially with frequent episodes but these have gradually been reducing in frequency and I’ve been in NSR now for over 13 weeks. Current medication is 2x 50mg Flecainide daily plus Apixaban as well as medication for hypertension. I’m keen to maintain my health through exercise and enjoy running, swimming and cycling.
I have agreed with my EP to avoid Beta Blockers as they restrict my HR to the extent that my pace is heavily impacted. However, my HR on exercise is still very much below my contemporaries and I struggle to get it over 145 ever and at 140, it’s like I’m flat out.I have read contradictory views on whether Flecainide has an impact on HR.
So, my question to the panel is:
Is there anyone else who is on Flecainide but not Beta blockers who exercises regularly and do they think Flecainide impacts their performance or not?
If there is evidence that Flecainide does impact HR, then I am considering discussing with my Cardiologist, dropping the daily Flecainide for a PIP approach. I can always return to daily if frequency increases.
Any examples of similar experiences with outcomes would be helpful.
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I’m well past intense exercising now but personal experience, study and reading threads on this forum around exercising whilst on drugs for AF have taught me one essential truth:- If your body says NO then listen to it because it’s far more intelligent than you and try fight it and you will lose.
Loads of threads on this issue of which this is just one on ‘effect of Flecainide on exercise is quite typical
Have you read any of the blogs/books written by cardiologists who are endurance athletes and who also developed arrythmias and then studied and wrote about it?
Thank you CD for the references. Some reading to be done. At 57 I’m long past chasing PBs though I do want to maintain reasonable fitness for general health reasons, I continue to adapt my eating with experience. As ever, it’s about finding the right compromise and as is so often demonstrated on this site, there’s no one size that fits all. I’m hoping that I can get feedback of what is possible and try to then decide (and maybe a little through trial and error) what my appropriate compromise is. I fully accept that with age there will be some creep and so will have to monitor and adapt (meds / exercise regime) to try to avoid too fast a decline. It’s all about QOL and getting that balance between short and long term.
on this ... Is there anyone else who is on Flecainide but not Beta blockers who exercises regularly and do they think Flecainide impacts their performance or not? ...
there was a short time that I was on flecainide but not beta blockers ... two points
First - yes, it did affect my performance - reduced it from slow to slower
Second - if i recall correctly you should not take flecainide without taking beta blockers as flecainide alone can do some weird shit, but double check this point. The cardiologist who prescribed flecainide (alone) to me was not an EP and should not have done that.
Flecainide is not, as we say in South Africa, a lekker medicine.
I didn't know that Flecainide should be taken with beta-blockers or in my case, a calcium channel blocker? I was taken off dilitiazem and given a much higher dose of flecainide and I was really ill for a month until I could get it sorted out. I wish I'd known at the time, but like most people I was brought up to habitually trust doctors to know what's best for my health.
There is concern / evidence that in some cases Flecainide on its own can be pro-arrhythmic and so is generally prescribed with a BB too. There are occasions though where BBs lower the RHR too low and have to be dropped and just Flecainide taken.
My Consultant cardiologist wasn’t comfortable on first consultation when he found I’d been put on Flecainide for AFL, though he didn’t take me off it.
In agreement with EP, we decided to drop the BB due to the impact on ability to exercise on the basis of QOL.
i was on flec for seven years no effect on running, cycling etc whereas betablockers even in a tiny dose make me breathless immediately. Hope this helps
I started experiencing AF about 18 months ago, usually brought on by exercising. Diagnosed formally this April, I had an ablation in early Aug. Was put on Flecainide and Bisoprolol. After the op, and on the medication my HR was stuck under 50, often mid 40s. After a few weeks I was worried how low my HR was and the breathlessness that came with it. My consultant said to stop the Bisoprolol, and this helped to reduce the lethargy and my HR was then typically nearer 50 (still low for me). At a 6 week review I said my HR still seemed low and the consultant said to try stopping the Flecainide, and take Fl/Bis as a PiP if needed. Within days my HR moved to high 50s/low 60s. Sorry, a long story to say that Flecainide did seem to lower my HR!
I've been on Flecainide for nearly a year now and the results in terms of exercise have been very positive. My average HR on a steady 30 mile bike ride has gone down from 152 BPM to around 120 and on a short run (I have an artificial knee so no long runs for me) has gone down from 175 to 135.
Max HR in both activities could easily hit north of 210 prior to taking flecainide, which for someone pushing 60 is alarming but I could never get the Drs, including cardiologists, to take this seriously - I think because my resting rate has always been in the low 50's. It now rarely goes over 180.
My swimming time for 1500 metres is back to 30 mins at steady pace without huffing and puffing at the end, previousy I was over exerting to get to 35 mins.
After a few months atrial flutter was detected (probably caused by the Flec) so I was put on beta blockers to stop the possibility of ventricular arryhthmias but they turned my into a physical and mental zombie (max cycling HR even up steep hills was 120) so I stopped these after 6 weeks.
My initial Flec dose was 50 mg x 2 but I have cut the morning dose to 25 mg and this has greatly reduced, if not eliminated, the flutter whilst still controlling the afib and maintaining the exercise benefits.
Generally the Flec has improved my life. I'm not as tired as I was generally and exercise is easier at the same pace that was knocking me out previously.
I'm still worried about the flutter it seems to have induced but this has never transmitted to the ventricles. If my HR ever goes above the 180 mark I stop exercising immediately and it drops straight back down.
Thanks for info on your experience. Just for clarification, you mention A Flutter. Did you have AF, then take Flecainide solely but then developed AFl and then put on BBs as well? When you talk of a drop in HR when on Flec. Presumably that is relative to HR when in AF?
How did your HR on Flec compare to pre AF / AFl? Presumably then, with a lower HR, your pace is slower than pre-AF?
I understand the smallest dose for Flec is 50mg so did you split pills?
Took Flec solely and the developed flutter so was put on BBs.
HR reductions are when exercising and not in AF. I'm generally not in AF thanks to the Flec. If I stop Flec I get episodes of AF.
My pace is now comparable to pre AF but at lower HR. I say comparable, I'm older and don't train anything like as hard so not quite at the levels 10 years ago but exercising HR is better. I "feels" more efficient.
I actually snap the pill in half by hand. Works better than a pill splitter
thanks for clarification. So, suggests that relative to pre-arrhythmia , when taking Flecainide, your HR is lower for the same output, suggesting that somewhere there’s been an increase in efficiency within your system, although you say hard to compare as now older and training at lowest intensity.
For me, I think my HR is lower but my pace is lower too. One complication however, is I had Covid 2 months after Ablation and although I was not seriously I’ll, I believe it had a medium term (still minor and apparent only at higher intensity exercise 9mths later) impact on my lungs so I don’t know if that is a cause / partial cause of the slower pace I’m experiencing.
I am on 200mgs Flecainide only. I have changed from more intensive exercise to moderate as I recognised the former was an AF trigger.I have been AF free for many years.
I found Flecainide reduced my HR a tad, around 5 points. I have plenty of energy at 69yo and excellent QOL.
I would say it is too early for you to drop to Flec PIP. My cardiologist was against the 'rollercoaster' of PIP and changing dose levels despite my success; the heart seems to adapt and provide stability if you adopt a consistent approach.
I think you need to ask a specialist about this, if that’s a realistic possibility for you. A cardiologist with an interest in sports physiology perhaps.
One thing that the debate which this post has prompted is to show that we're all different and we probably get different advice and recommendations. My experience is this. I've always kept myself very fit through various sporting activities. I started with PAF in 2007, aged 52. At the time, doctors seemed to be saying it was either Flec or beta blockers not both. We opted for just Flec so that my performance was not affected. During one period when AF was becoming frequent,/severe, I upped the dose (as per doc's advice) but this did become pro-arrythmic, with some real odd stuff happening (ECGs diagnosed ventricular arrhythmia - seriously bad news - but cardiologists finally decided it was not). But, after that I went to 2× 100 Flec and 1.25 bisoprolol per day. I stayed on this for some years with ups and downd on levels of AF. But, ver the last 10 months, AF has been minimal (a total of only 3 hours in that time), and I've dropped the Bisoprolol and kept Flec the same.
Ever since I have had AF, I have maintained a high level of physical activity, but now try to avoid ong tiring days (which make me vulnerable to vagally mediated AF). I'm a mountain/rock climber so this can be an issue but I managed a 7.5 hour day out yesterday, ascending around 4000ft, without I'll effect. I suppose the key thing is, whether AF is involved or not, is to get fit gradually (listening to you body's feedback) and then stay active. That's my intention anyway.
I have been taking Flecainide for about 15 years eventually going up to 150mg x2 a day. I tried BB early on and felt awful so I was given Verapamil a CBlocker which I have taken ever since. I am 74 and have played tennis twice a week for about 25 years. When AF started to happen during tennis I agreed to an ablation. I had an ablation 5 years ago which was successful although they think I have an occasional flutter which I don’t really notice so I now take 2x50mg Flecainide daily plus 120mg verapamil plus apixipan. I think you are supposed to take either a BB or Channel blocker with Flecainide. I still now play tennis twice a week and often do 18 holes of golf with no problems (other than I am pretty tired after the golf!)
I am unable to take flec but I'm on 2.5mg Bisoprolol and am also a keen runner. The BB affect performance but at 69 I now just run for enjoyment. I would say it adds on 30 seconds a kilometre to my times but it cuts down on my afib episodes.
I was on flecainide with no beta blocker for 18 months and do loads of exercise working to maximum heart rate. There was no impact to my heart rate from flecainide but I realise everyone is different. Hope you get things sorted out.
"Is there anyone else who is on Flecainide but not Beta blockers who exercises regularly and do they think Flecainide impacts their performance or not?"
I am in this exact situation. Also had an ablation around the same time you did. I am 60, so probably a similar max heart rate to you. I dropped the beta blocker because I could not get my HR above about 120. I have tried the flecainide as PIP and also on regular daily dose. As PIP, my max HR is not affected and is around 170. When my afib episodes became weekly, I switched to daily flecainide, and my max HR then reduced to around 145. I found this did not have much effect on my pace. I can still do a half marathon in 2:25, which is about average for my age group. I was doing the same pace before flecainide, so I don't think it has much effect, to answer your specific question. In a race, my HR will eventually climb to around 155, so you might find that your max HR is a bit higher than what you see in training. I think the flecainide smooths out the HR at the high end, and I find I don't really need to look at it much, it just sits at one rate. Without flecainide, my HR would hunt around a bit between 140-175. I think the higher end of the HR zone wasn't really adding much pace, at least for me.
I usually run about 4 miles per day (10 minute pace) and walk an additional 6 miles. If I take the flecainide every day, I don't get any afib. Without it, maybe 2 hours per month. I don't feel like this amount of exercise provokes any extra afib.
I posted a similar question a few days ago and received advice/comments similar to the ones you have received. I am 68, a lifelong single sculler, and was diagnosed with lone paroxysmal afib in January 2020 (if memory serves me). I have been on 2x100 mg flecainide along with apixaban and rosuvastatin with no noticeable side effects since shortly after my diagonosis. During my first year after diagnosis I was very tentative about training, but now that I have a clearer understanding of my limits I can once again push myself. I now train an hour/day five days a week on the rowing machine, which is about the same training load as before my diagnosis. Since I wear a heart rate chest monitor I can quantify performance before and after afib and flecainide. Prior to afib/flecainide I did sub 2minute/500meter split times over a 2000 meter distance with my heart rate maxing out at 150 bpm. In 5 km time trials my split times were 2:05-2:10/500m and my heart rate was around 140 bpm for most of the distance, spiking to 150 or higher in the final sprint. Post afib/flecainide my heart rate will not go over 130 no matter how hard I push. My split times over 2000 m are now 2:10 at a heart rate of 125-130; over 5 km my heart rate it sits at 120-125 bpm and my splits are 2:15-2:20. So I guess you could extrapolate that my max heart rate has fallen by about 20 bpm or about 12% and that my performance has fallen commensurately. I no longer have a desire to compete and am happy just being healthy and being able to be active within my new limits. I hope this helps.
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